Department of Orthopaedics, Kaiser Permanente Southern California, Baldwin Park, California, USA.
Department of Orthopaedics, Kaiser Permanente Southern California, Panorama City, California, USA.
Am J Sports Med. 2024 Oct;52(12):3065-3074. doi: 10.1177/03635465241278358.
Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group.
PURPOSE/HYPOTHESIS: The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered.
Cohort study; Level of evidence, 3.
Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity.
A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 ± 8.7 years; mean follow-up was 53.3 ± 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; < .001), Oxford (25.2 to 46.2; < .001), and VAS (6.8 to 0.9; < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; < .001), Oxford (23.4 to 44.2; < .001), and VAS (7.3 to 1.3; < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; = .50) or Oxford (33.5 to 31.4; = .81), but there was a significant reduction in VAS (7.1 to 5.4; = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; = .59), Oxford (46.2 vs 44.2; = .07), VAS (0.9 vs 1.3, = .42) and SANE (85.4 vs 83.2; = .92) scores. However, group 3 had significantly lower ASES (45.8; < .001), lower Oxford (31.4; < .001), lower SANE (45.4; < .001), and higher VAS (5.4; < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex ( = .72), previous surgery ( = .06), preoperative acromiohumeral distance ( = .57), and preoperative Goutallier stage of the supraspinatus ( = .16).
Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft.
目前为止的关于上盂唇前后部重建（SCR）的研究比较了愈合的移植物和撕裂的移植物的结果，没有根据撕裂的位置对移植物撕裂进行分类，而是将所有撕裂合并并报告为单一组。
目的/假设：本研究的目的是通过真皮同种异体移植物的 SCR 来评估功能结果与移植物完整性和移植物撕裂位置的相关性。假设完整移植物的患者的功能结果将与覆盖结节的移植物撕裂的患者等效。
队列研究；证据水平，3 级。
纳入在单一机构接受真皮同种异体移植物 SCR 的患者。记录术前和术后美国肩肘外科医生（ASES）评分、牛津肩肘评分、视觉模拟评分（VAS）疼痛评分以及术后单项评估数值评估（SANE）评分。术后进行磁共振成像（MRI）扫描以评估移植物完整性。
共有 39 名患者符合纳入标准。患者平均年龄为 60.4±8.7 岁；平均随访时间为 53.3±25 个月（范围，14-98 个月）。MRI 检查平均在术后 17.5 个月（范围，6-66 个月）进行，结果显示 14 例（36%）患者移植物完整；11 例（28%）患者来自关节盂，4 例（10%）患者来自移植物的中间部分，8 例（21%）患者来自结节；2 例（5%）患者完全没有移植物。患者分为 3 组：组 1（完整移植物）、组 2（覆盖结节：关节盂和中间部分撕裂）和组 3（暴露结节：来自结节的撕裂和溶解或缺失的移植物）。在组 1 中，ASES（从 37.9 到 88.5；<0.001）、牛津（从 25.2 到 46.2；<0.001）和 VAS（从 6.8 到 0.9；<0.001）评分显著改善。在组 2 中，ASES（从 32.2 到 86.1；<0.001）、牛津（从 23.4 到 44.2；<0.001）和 VAS（从 7.3 到 1.3；<0.001）评分显著改善。在组 3 中，ASES（从 40.3 到 45.8；=0.50）或牛津（从 33.5 到 31.4；=0.81）评分没有显著改善，但 VAS（从 7.1 到 5.4；=0.03）评分显著降低。组 1 和 2 的术后 ASES（88.5 与 86.1；=0.59）、牛津（46.2 与 44.2；=0.07）、VAS（0.9 与 1.3；=0.42）和 SANE（85.4 与 83.2；=0.92）评分无显著差异。然而，组 3 的 ASES（45.8；<0.001）、牛津（31.4；<0.001）、SANE（45.4；<0.001）和 VAS（5.4；<0.001）评分显著低于组 1 和 2。基于性别（=0.72）、先前手术（=0.06）、术前肩峰肱骨头距离（=0.57）和术前冈上肌 Goutallier 分期（=0.16），结果无差异。
通过真皮同种异体移植物行 SCR 并发生结节覆盖的移植物撕裂的患者，其功能结果与完整移植物的患者等效。
